NPI | 1558631713 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: PA MD450593) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD450593) |
Enumeration Date | 2012-01-05 |
Last Update Date | 2013-12-17 |